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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502701055
Report Date:
05/07/2024
Date Signed:
05/07/2024 03:10:37 PM
Document Has Been Signed on
05/07/2024 03:10 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
ASPEN VILLE CO
FACILITY NUMBER:
502701055
ADMINISTRATOR:
BHATIA, JASRAJ
FACILITY TYPE:
740
ADDRESS:
5412 KIERNAN AVENUE
TELEPHONE:
(209) 566-8080
CITY:
SALIDA
STATE:
CA
ZIP CODE:
95368
CAPACITY:
32
CENSUS:
30
DATE:
05/07/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
Director of Sales Karen Langley
TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conducted Case Management visit and met with Director of Sales Karen Langley and explained the reason for the visit.
On 5/7/2023 LPA Lund verified that staff member (S1) has not been working at the facility since about 1/15/2024.
No deficiencies cited during the visit. Exit interview conducted and copy of report left at facility.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Jason Lund
TELEPHONE:
(916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE:
05/07/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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